Bile Reflux

Bile reflux is when the bile that empties into your small intestine (duodenum) washes back into your stomach and, sometimes, into your esophagus. Another name for it is non-acid reflux.

Bile is a strong digestive juice that helps your body break down fats. Your stomach and esophagus aren’t made to handle lots of it. So, your pyloric muscle keeps bile from getting into areas it shouldn’t. But if the pyloric muscle or duodenum isn’t able to do its job, bile can flow backward. This irritates the lining of your stomach and esophagus, which causes inflammation.

Inflammation is a natural response that starts the healing process. But it’s not healthy for your gastrointestinal (GI) tract to be in a constant state of stress because it can’t recover.

Without treatment, chronic inflammation from bile reflux can change your cells in ways that aren’t normal. This can lead to issues like ulcers and, rarely, cancer.

Bile reflux isn’t as common as acid reflux, but it can happen at the same time.

Symptoms of bile reflux

Symptoms of bile reflux can affect your stomach, esophagus and even your throat. You may experience:

• Abdominal (belly) pain
• A bitter taste in your mouth
• Heartburn
• Indigestion
• Loss of appetite
• Nausea
• Regurgitation
• Sore throat and hoarseness
• Yellow-green vomit

These symptoms can feel very similar to those of acid reflux. But bile reflux doesn’t respond to the same antacid treatments and may get worse over time.

What causes bile reflux?

Your pyloric muscle sits between your stomach and small intestine. It acts like a valve to make sure everything in your stomach goes one way: down. But when something keeps the valve from working normally, bile can build up in your stomach and regurgitate into your esophagus.

This can happen because of:

• Surgery on your digestive organs: These procedures can change the way your body stores and releases bile. They can even go around your pyloric valve altogether. This can allow bile to move upward with less resistance.
• Peptic ulcers and scar tissue: These can block or narrow your pyloric valve and keep it from doing its job.
• Conditions that slow down digestion and bile flow: These can cause a kind of traffic jam that exposes your stomach and esophagus to bile.

Risk factors

Your risk of bile reflux is higher if you’ve had:

• Gallbladder removal surgery
• Gastric resection surgery (Billroth I and II)
• Bariatric surgery, like duodenal switch
• A history of smoking
• Gallbladder disease
• Gastroparesis
• Peptic ulcers

Complications of bile reflux

Bile reflux itself isn’t dangerous. But without treatment, the damage it causes can open the door for other more serious GI conditions.

Untreated bile reflux can cause chronic inflammation in the lining of your stomach (bile reflux gastritis) and esophagus (bile reflux esophagitis). This can lead to reactive chemical gastritis, erosions, ulcers, scarring and a condition called Barrett’s esophagus. It also raises your risk of cancer in your stomach and esophagus.

How doctors diagnose bile reflux

Your provider may use a few different tests to diagnose bile reflux. These include:

• Bilitec® monitoring system: This is a tiny probe your provider puts inside your esophagus. When you have esophageal reflux, the probe detects how much bile is coming back up.
• Esophageal impedance test: A provider places a small catheter up your nose and into your esophagus, where your reflux is monitored for 24 hours. This test can confirm reflux into your esophagus and find out what the reflux is made of.
• Hepatobiliary iminodiacetic acid (HIDA) scan: This radiographic imaging test tracks the flow of bile from your liver to your small intestine.
• Upper endoscopy exam: A provider puts a tube with a tiny camera attached (endoscope) down your throat and into your stomach and small intestine. The endoscope can also take tissue samples to study in a lab.

How is bile reflux treated?

Healthcare providers prescribe many medications to treat bile reflux. These medications help ease your symptoms by binding bile acids, protecting your stomach lining or improving your stomach’s ability to push food along. These include:

• Sucralfate, which coats and protects the lining of your stomach and esophagus
• Baclofen, a medication that decreases the relaxation of your lower esophageal sphincter or increases the pressure of the lower esophageal sphincter and prevents bile from going into your esophagus
• Bile acid sequestrants (cholestyramine), which bind and disrupt the circulation of bile
• Ursodeoxycholic acid (UDCA), which changes the bile composition in your stomach

There may also be a link between gastric upset and mood because of the gut-brain connection. Talk therapy could help ease your symptoms as part of your overall treatment plan.

If these don’t work and your symptoms are still severe, your provider may recommend anti-reflux surgery (Nissen fundoplication). This strengthens your lower esophageal sphincter in case of esophageal bile reflux.

When should I see my healthcare provider?

If you’re dealing with reflux symptoms that keep coming back, your stomach or esophagus may be facing constant irritants.

If it’s acid reflux, you might be able to manage it with over-the-counter antacids and changes to your daily routine. But you may have bile reflux if your symptoms don’t go away or include abdominal pain.

If this sounds like your situation, reach out to a healthcare provider. They can find out what’s really going on and prescribe treatments that work for you. They’ll also make changes to your treatment if you still have problems.

What can I expect if I have bile reflux?

Bile reflux can take a toll on your digestive system. And it may take some time to find a treatment, or combination of treatments, that works. As you navigate your care plan, things that may help you feel a little better include:

• Eating dinner earlier in the evening to give your body time to digest
• Maintaining a weight that’s healthy for you
• Raising the head of your bed

Your healthcare provider is the best person to talk to about what you can expect going forward.